Health Care in Eastern Ukraine: An Overview
Authors: Olga Salamadze, Tamaz Salamadze
Journal: Annals of Internal Medicine (2022)

On Being a DoctorOctober 2022Health Care in Eastern Ukraine: An OverviewFREEOlga Salamadze, MD and Tamaz Salamadze, MDOlga Salamadze, MDRivne Hospital Ukraine, Rivne, UkraineSearch for more papers by this author and Tamaz Salamadze, MDLuhansk State Medical University, Rivne, UkraineSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-2309 Audio Reading - “Health Care in Eastern Ukraine: An Overview” Audio. Michael A. Lacombe, MD, Annals Associate Editor, reads “Health Care in Eastern Ukraine: An Overview” by Olga Salamadze, MD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail On February 24, Ukraine was attacked by Russian troops. Rubizhne—a city in eastern Ukraine with a population of 60,000 people that is just over 80 km from the Luhansk People's Republic (an unrecognized republic that was proclaimed by pro-Russian protesters)—was bombarded in the initial attack. Rubizhne residents were awakened by explosions and the roar of aircraft. You have already seen the media coverage of our devastation. We write this to give you some idea of the medical implications of such a disaster and the tasks facing physicians such as us.Military invasion leads to severe emotional stress in the population. Hypertensive crises and panic attacks would be predictable; however, contrasted with what was to come, we would consider them minor. To prepare initially, patients admitted to hospitals had to be discharged ahead of schedule. We were compelled to focus on the huge influx of patients with military traumas. In addition, we had a dire need for equipment and supplies: anesthetics, hemostatic agents, blood products, and antibiotics. The conflict has triggered strong emotions among health care personnel—none of us believed that armed conflict could happen.From the start of the military invasion, residents tried to leave the city. Most of them moved to the western regions of the country or abroad. The effect of this crush of traffic was inevitable. In the first 3 days, the number of people who needed trauma care because of road accidents overwhelmed us. Later, people were shot while trying to leave. The number of civilians who died during this period is impossible to determine because this territory is occupied or active hostilities are underway.For evacuating residents who did not have a personal car, government organizations provided special evacuation trains; later, when the railway was destroyed, evacuation was attempted by buses. Our own friends and colleagues took advantage of this opportunity later. As of today, the United Nations High Commissioner for Refugees estimates that over 5.8 million refugees from Ukraine are present across Europe, and over 3.6 million refugees have registered for temporary protection or similar national protection schemes in Europe. Emergency service vehicles assisted in the evacuation process. In the ensuing days, medical care became irregular and sporadic in area hospitals.Rural towns in Ukraine are mostly composed of elderly people or children. Because we experienced a similar conflict in our area, Luhansk, in 2014, we anticipated that elderly people and those with disabilities or chronic diseases that require therapeutic adherence would be threatened first. The health professionals at primary and secondary levels informed patients about the need to stock up on reserves of medicines. A government call center for free medical consultations was set up.In the beginning of March, military battles began in the city. With the increase in shelling, more and more health care workers moved to safe regions. Many medical and pharmaceutical workers went missing. Their fate is still unknown. Other health care specialists voluntarily enlisted as military doctors and nurses in the Ukrainian military forces. Our tasks were to provide free medical consultations and find medications for refugees as well as patients in occupied territories.Russia's invasion of Ukraine triggered a major humanitarian crisis in Rubizhne. In March, electricity, gas, and water supplies were disabled. It was not possible to cook food. Our houses were cold. People prepared food on a bonfire or soaked cereal in water, took water from rivers or lakes, and melted snow or ice. Personal hygiene was very poor or even impossible to maintain. Electronic services and communication technologies were not available. Life was like a postapocalyptic novel that differed only in that the main victims were children, women, and elderly people.Portable generators were scattered throughout the city but were hardly sufficient for 60,000 people. Shops were burned down during military action. The bazaar (a market consisting of rows of shops and stalls selling miscellaneous goods) was looted by occupying soldiers, and its last remnants were looted by the local populace. People who remained in the city died from explosions or succumbed to chronic diseases (including diabetes mellitus, COPD, cardiovascular diseases, and cancer). Acute respiratory viral diseases and pneumonia were the most common infectious diseases. Morgues were overcrowded. No one buried the dead. The main department of our hospital was destroyed by an explosion and closed. The hospital medical director refused to take action. A similar situation occurred in 2014: After Russian occupation, medical devices and medicaments were sold by some medical directors in Lugansk illegally and the money was laundered.Many of the dead remained on the streets for days. People who stayed in the city might be able to obtain medical support only by contacting their family doctor via electronic instant messengers or the government call center. Messengers gave patients information about medicine exchange among the city residents. The messengers also conveyed information about whatever limited medical care might be available.The city was occupied by the Russian army in April. We were swept with grief, profound loss, anxiety, and fear—our hearts were broken. Our hospital medical director collaborated with Russian militants. Our modern hospital equipment and medicine supplies that had been purchased in Ukraine in previous years were instead represented by Russian propaganda as humanitarian aid provided to the city's residents by the Russian government. The most recent news about the city's officials is that collaborators are being replaced by Russian administrators.Doctors who left for territories still controlled by Ukrainian forces helped find employment through professional associations. Medical workers from the occupied territories received the status of internally displaced persons and could receive state material assistance every month. Yet, medical care faced crises of devastated health facilities, mass migration, lack of personnel, and disease burden (such as war-associated trauma, mental illnesses, noncommunicable pathology, and infectious diseases). Thus, health professionals at the primary, secondary, and tertiary levels were compelled to augment their knowledge, training, and expertise to address war—especially in trauma medicine, mental health, and infectious diseases.When opportunities for experience are scarce, education and training strategies provided through digital technologies become essential for maintaining skills. The active support from international organizations and volunteers and the active role of medical staff will help improve the health care system in Ukraine. Destroyed hospitals are being rebuilt.From the West, Ukrainian health care receives and needs ever more medicines (such as anesthetics, tetanus vaccines, antibiotics, and insulin) and medical equipment (including that for surgical and trauma care and electrocardiogram machines). We thank you for that. We are so grateful.Telemedicine teaching is always welcome. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Olga Salamadze, MD; Tamaz Salamadze, MDAffiliations: Rivne Hospital Ukraine, Rivne, UkraineLuhansk State Medical University, Rivne, UkraineCorresponding Author: Olga Salamadze, MD, SE “LSMU” 16 Lipnya str., 36, Rivne 33000, Ukraine; e-mail, salamadze.olga@gmail.com.This article was published at Annals.org on 23 August 2022. PreviousarticleNextarticle Advertisement Audio Reading - “Health Care in Eastern Ukraine: An Overview” Audio. Michael A. Lacombe, MD, Annals Associate Editor, reads “Health Care in Eastern Ukraine: An Overview” by Olga Salamadze, MD Your browser does not support the audio element. Audio player progress bar Step backward in current audio track Play current audio trackPause current audio track Step forward in current audio track Mute current audio trackUnmute current audio track 00:00/ FiguresReferencesRelatedDetails Metrics October 2022Volume 175, Issue 10Page: 1487-1488 ePublished: 23 August 2022 Issue Published: October 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...